Retiree Solutions Quality Director - RN Dallas/ Forth Worth,TX(Job Number:706375)
UnitedHealthcare is part of the family of companies that comprises UnitedHealth Group, the national leader across most major segments of the US health care system.
When you use your skills, talent and energy for the members of UnitedHealthcare, you'll be able to do more and do it better. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care in the Medicare and Retirement population that we serve. We contract with states and other government agencies to provide care for these individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
By tapping into our extensive knowledge base to manage care plans for retirees, elderly, disabled, and chronically ill people, you'll ensure that their unique needs are fully understood by all care givers. In short, you'll help make a huge health care system work like a personalized health care team.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. This team is comprised of individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
The United Retiree Solutions (URS) Clinical & Quality Team is responsible for ensuring our Group Medicare Advantage members live healthier Lives by receiving the right care, at the right time, and at the right place. We support the largest group Medicare Advantage plan in the nation. This clinical position is located in Texas and is responsible for the overall account relationship including strategic planning in relation to plan medical performance, consultative services, recommendations for benefit design, closing gaps in care, improving clinical outcomes and identifying medical expense management opportunities. This position will oversee clinical services offered to retirees under the contract with Alabama Public Education Employee’s Health Insurance Plan (AL-PEEHIP) and interfaces with enterprise-wide clinical staff working serving this account. The position works closely with local UHG market teams to research, develop and present new or existing strategies to improve quality/Star rating performance, reduce inappropriate medical spend, ensure accurate documentation of members conditions and increase Net Promoter Scores.
This position reports directly to the Vice President of Clinical Quality and indirectly to the Director of Clinical Development, Public Sector and Labor.
- Provides day to day clinical account management support for assigned employer group account(s)
- For assigned employer group account(s) is the liaison to the URS Client Management Team and the employer group account(s) for improving Star ratings, risk adjustment accuracy and medical cost reduction opportunities
- Provides real time data informatics and clinical support to the Medical Director(s) for assigned employer group account(s)
- Build strong relationships and partner with local market teams and internal clinical teams (Optum, HouseCalls, UnitedHealth Network, United Clinical Services UHC Medicare and Retirement and UHC Employer and Individual) to drive successful outcomes and improvement opportunities
- Educate and partner with market teams on specific needs for URS business priorities
- Participate in UHG market meetings to represent URS needs and look for opportunities to leverage or expand local market initiatives
- Create monthly report highlighting employer group account specific performance and state performance; highlight recommendations for performance improvement and ensure initiatives are in place to achieve goals
- Negotiate priority initiatives and strategies with senior business leader for the assigned state(s) and employer group(s)
- Ensure all Star related activities within Alabama are achieving the desired 4 star results
- 25-50% travel
Job Clinical Program Management
Primary Location US-TX-Dallas
Other Location US-TX-Fort Worth
Organization E&I United Retiree Solutions
Number of Openings 1